title: The paradox of disease prevention: celebrated in principle, resisted in practice.
abstract: Prevention of disease is often difficult to put into practice. Among the obstacles: the success of prevention is invisible, lacks drama, often requires persistent behavior change, and may be long delayed; statistical lives have little emotional effect, and benefits often do not accrue to the payer; avoidable harm is accepted as normal, preventive advice may be inconsistent, and bias against errors of commission may deter action; prevention is expected to produce a net financial return, whereas treatment is expected only to be worth its cost; and commercial interests as well as personal, religious, or cultural beliefs may conflict with disease prevention. Six strategies can help overcome these obstacles: (1) Pay for preventive services. (2) Make prevention financially rewarding for individuals and families. (3) Involve employers to promote health in the workplace and provide incentives to employees to maintain healthy practices. (4) Reengineer products and systems to make prevention simpler, lower in cost, and less dependent on individual action. (5) Use policy to reinforce choices that favor prevention. (6) Use multiple media channels to educate, elicit health-promoting behavior, and strengthen healthy habits. Prevention of disease will succeed over time insofar as it can be embedded in a culture of health.
authors.affiliation: Institute of Medicine, Washington, DC 20001, USA. fineberg@nas.edu
authors.forename: Harvey V
authors.initials: HV
authors.lastname: Fineberg
mesh_terms: D016265:Conflict of Interest; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D004649:Employee Incentive Plans; D015438:Health Behavior; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D010353:Patient Education as Topic; D011315:Preventive Medicine / Q000191:economics* / Q000379:methods; D011322:Primary Prevention / Q000191:economics / Q000379:methods; D013997:Time Factors